Helping You Successfully Overcome Severe Depression

What is esketamine?

Esketamine is made from a drug called ketamine, an anesthetic that has also been used for many years to treat depression. Esketamine, a more potent version of ketamine, is approved by the FDA in March 2019 under the brand name Spravato® in the form of a nasal spray added to a conventional antidepressant as a therapy for treatment-resistant depression (TRD) as well as major depressive disorder (MDD) in adults who have tried at least two other antidepressants for at least six weeks each and haven't experienced remission or had intolerable side-effects. Esketamine, unlike other conventional antidepressants, increases levels of glutamate, the most abundant chemical messenger in the brain. This results in a greater impact on more brain cells at one time. Esketamine is administered by the patient in the doctor's office via intranasal route. Esketamine can provide almost immediate effects oftentimes can be maintained by providing continued or intermittent dosing.


Spravato® is a prescription nasal spray, taken with an oral antidepressant used to treat adults with treatment-resistant depression (TRD) as well as major depressive disorder (MDD).

Greater reduction of depressive symptoms at four weeks along with an oral antidepressant.

Spravato® is approved by FDA and covered by insurance.

During treatment, you may feel dizzy, euphoric, or intoxicated. You can't do anything hazardous for the rest of your day, so you'll need someone to drive you home after treatment.

Nasal spray you self-administer under the supervision of a healthcare provider.

Tell your doctor if you have a history of drug or alcohol abuse.

How to get started

Free screening

Preliminary screening for Spravato®

In the preliminary screening for Spravato®, we will review your medical history and can help prospective patients, their families, and loved ones verify their insurance coverage for Spravato® treatment.

All inquiries are fully confidential and always free.

Take the first step

Get started today with a free, fully confidential consultation.
To schedule an evaluation, please fill out
FREE Spravato® screening form  or  CALL US.

Figure out if Spravato® treatment is right for you

During this session, we will conduct a thorough evaluation of your health history, current symptoms, and prior therapies, as well as answer any additional questions you may have about our process and treatment. We will also discuss whether or not Spravato® is right for you and the necessary Spravato® treatment protocol that is best suited for your diagnosis and symptoms.

We take time to conduct a thorough assessment of your symptoms and history so that we can tailor a treatment plan that is unique to you and promotes an optimal outcome.

If determined that Spravato® is the best treatment option for you, you are ready to move forward with treatment process.

Tell your doctor if:

  • You have heart, brain, or liver problems.
  • You have ever had a condition called 'psychosis'.
  • You are pregnant or plan to become pregnant.
  • You are breastfeeding or plan to breastfeed.
  • You have any other medical conditions.
Tell your doctor about all the medicines that you take, including prescription and over-the-counter medicines, vitamins and herbal supplements. Taking Spravato® with certain medicine may cause side effects.

What to expect when getting Spravato®

Preparing for treatment

On the day of your appointment, avoid eating two hours before and consuming liquids 30 minutes before your session. This is because food and drink immediately before Spravato® can cause an upset stomach in certain people.

If you take a nasal corticosteroid or nasal decongestant medicine, take these medicines at least one hour before taking Spravato®.

You'll need to plan for rides to and from our Spravato® treatment center and should refrain from driving for at least 24 hours.

You may want to bring a book, a relaxing playlist or another form of entertainment for the session because your doctor will monitor you for at least two hours after treatment.

Blood pressure check

Before beginning Spravato® treatment for the day, the healthcare professional will check your blood pressure. If everything appears to be in order, you're ready to get started.

Spravato® administration

You will self-administer Spravato® nasal spray under the supervision of a healthcare professional, who will show you how to use the nasal spray device, and will tell you how much Spravato® you will take and when you will take it.


After the Spravato® has been administered, all that's left is to relax and experience treatment for the next two hours. The healthcare professional will check your blood pressure again about forty minutes into treatment and will check a final time at the end of the two hours.

After two hours, you're done with treatment for the day. Spravato® treatment and experience varies from person to person. Most often, the experience is guided by patients' own intentions and treatment goals. Be sure to take it easy for the remainder of the day.

Your health, safety and well-being is our top priority

During Spravato® treatment, you may experience dizziness, anxiety, nausea, dissociation, or increased blood pressure.

Let's know right away if you feel like you cannot stay awake or if you feel like you are going to pass out.

The healthcare professional will be on-site and nearby for the duration of your treatment to answer any questions you may have, or assist with other requests as needed.

Do not drive, operate machinery, or do anything where you need to be completely alert after taking Spravato®. Do not take part in these activities until the next day following a restful sleep.

Because of the risks for possible side effects, abuse and misuse, Spravato® can only be administered at healthcare settings certified in the Spravato® Risk Evaluation and Mitigation Strategy (REMS) Program, and to patients enrolled in the program.

Know more about safety and tolerability of Spravato®

Typical treatment course

Weeks 1-4

2 treatments / week

Weeks 5-8

1 treatment / week

Weeks 9 & beyond

1 treatment every 1 or 2 weeks

We will help you find out if Spravato® is right for you!

To schedule an evaluation, please fill out
FREE Spravato® screening form  or  CALL US.

Spravato® nasal spray device

spravato device

The science behind Spravato®

Mechanism of action

Spravato® (esketamine), the S-enantiomer of racemic ketamine, is a non-selective, non-competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor, an ionotropic glutamate receptor. The precise mechanism by which esketamine exerts its antidepressant effect is unknown. The major circulating metabolite of esketamine (noresketamine) demonstrated activity at the same receptor with less affinity. Clinical trials have shown a 69% response rate and 52% remission rate in patients treated with Spravato®.

How does Spravato® work for depression?

Conventional antidepressant medications increase levels of naturally occurring chemicals in the brain such as dopamine, serotonin, and norepinephrine. These chemical messengers also called neurotransmitters, initiate and regulate communication between various cells in the brain. Generally, greater levels of these neurotransmitters allow brain cells to communicate with each other better, positively affecting individuals' overall mood. Unfortunately, some people with depression don't respond to these types of conventional antidepressant medications.

Spravato® works differently than other antidepressant medications. Unlike other antidepressant medications, Spravato® increases glutamate, the most abundant neurotransmitter in the brain.

Glutamate is a powerful excitatory neurotransmitter, responsible for facilitating signals between nerve cells. As glutamate levels increase, the neurotransmitter starts to 'excite' cells in the brain. Glutamate also encourages the brain to learn, memorize, and become accustomed to this excited state of mind, helping to combat the symptoms of depression.

Clinical trial results show that esketamine can reduce symptoms of depression by helping the brain form new connections, allowing for behavioral and cognitive changes to occur more readily and rapidly in patients with treatment-resistant depression. Typically, brain cells under chronic emotional or physical stress diminish, but esketamine prevents this from happening. Additionally, esketamine can help promote brain cell growth and encourage neurogenesis, which forms new neurons and neural connections in the brain.

Frequently Asked Questions on Spravato®

Let us know about all of your health conditions and medicines and we will help you to find out if Spravato® is right for you.

To schedule an evaluation, please fill out
FREE Spravato® screening form  or  CALL US.

Most commercial insurance companies and Medicare cover the cost of Spravato® for patients who meet their criteria. We do a benefits investigation to determine if you will qualify if Spravato® is recommended after an initial consultation, and potential out-of-pocket costs of treatment.
To learn more about your insurance coverage for Spravato® and other resources, please call a Janssen CarePath Care Coordinator at 877-CarePath (877-227-3728), Monday-Friday, 8:00 AM to 8:00 PM ET, or visit  JanssenCarePath.com.

How long you stay on Spravato® based on how you respond to it and how stable that response is. Our healthcare professional will determine the dosing frequency based on how you feel.

In clinical studies, improvement of depressive symptoms was demonstrated at four weeks by Spravato® plus an oral antidepressant, compared with placebo nasal spray plus an oral antidepressant.

We will evaluate your symptoms of major depressive disorder over the four-week course of treatment to see if you have had satisfactory improvement.

Not all patients will respond to Spravato®. But do not stop your Spravato® treatments without first discussing your reasons, concerns, and appropriate next steps with our healthcare professional.

The most common side effects that can occur during and after taking Spravato® include:

  • Feeling disconnected from yourself, your thoughts, feelings and things around you (dissociation)
  • Feeling very happy or excited
  • Decreased feeling of sensitivity (numbness)
  • Feeling sleepy (sedation)
  • Increased blood pressure
  • Spinning sensation
  • Dizziness
  • Nausea
  • Vomiting
  • Lack of energy
  • Feeling anxious
  • Feeling drunk

If these common side effects occur, they usually happen right after taking Spravato® and go away the same day.

For more information, please see the  important safety information.

You cannot take Spravato® on your own. Spravato® cannot be purchased at a pharmacy. Because of the risks for sedation, dissociation, and abuse and misuse, Spravato® can only be administered at healthcare settings certified in the Spravato® Risk Evaluation and Mitigation Strategy (REMS) Program. You will administer Spravato® nasal spray yourself under the supervision of a healthcare professional, at a certified Spravato® treatment center.

That's okay! We will help you explore other options, if Spravato® treatment isn't right for you. We, at Holistic psychiatry also offer  TMS therapy,  which is a non-drug, non-sedating FDA-cleared treatment for depression.

Yes. You have to be on an oral antidepressant medication to receive Spravato® nasal spray.

Both Spravato® and ketamine are Schedule III controlled substances under the US Controlled Substances Act. Spravato® nasal spray is a derivative of ketamine. Spravato® is an FDA-approved nasal spray for treatment-resistant depression in adults. IV Ketamine has not been approved by the FDA to treat depression.

When you are receiving IV ketamine, you are connected to an IV drop of about 1/10 the amount of ketamine that is used as an anesthetic.
For IV ketamine treatments, they have proven to be more effective in treating major depression because the ketamine in the IV is more bioavailable and the drug is easily absorbed through the bloodstream. It has more immediate effects and may lead to a shorter overall treatment time depending on your symptoms.

Spravato® is sprayed up the nose and only takes a few minutes to administer.
For the Spravato® nasal spray, the esketamine has to pass through the tissues of the nose and sinuses to reach the brain and take effect. Because it has to be absorbed nasally, it can be less effective and take patients a longer time to feel the therapeutic effects of the drug. However, studies show that Spravato® can be very effective if paired with the right oral antidepressants.

Patients can schedule an appointment with the psychiatrist for Spravato® treatment evaluation by   CALLING  our office during normal business hours (8AM to 5PM, Mon-Fri) or by filling out  FREE Spravato® screening form